Scaling Up Endoscopic Tympanoplasty: A Dual-Station Workflow in Resource-Limited Settings

Area of Science:

• Otolaryngology
• Minimally Invasive Surgery
• Health Systems Research

Background:

• Endoscopic tympanoplasty offers advantages for treating middle ear pathologies.
• Resource-limited settings face challenges in providing surgical care, including ear surgery.
• Optimizing surgical workflows is crucial for expanding access to care.

Purpose of the Study:

• To evaluate the feasibility, outcomes, and safety of a dual-station (DS) workflow for endoscopic tympanoplasty.
• To compare the DS workflow with the conventional single-station (SS) approach in a resource-limited hospital.
• To determine the impact of the DS workflow on surgical capacity and patient results.

Main Methods:

• Retrospective chart review of patients undergoing endoscopic tympanoplasty at Maesot General Hospital.
• Comparison between dual-station (DS) workflow implemented during outreach missions and single-station (SS) surgery.
• Inclusion criteria: patients aged 18-80 years. Primary outcomes: graft success, operative time, complications. Secondary outcomes: audiologic results.

Main Results:

• The DS workflow facilitated 7.75 cases/room/day.
• Graft success rates were comparable between DS (82.14%) and SS (82.5%) groups (P=.999).
• Operative times, complication rates (no infections in DS vs. 1 in SS), and audiologic outcomes (air-conduction thresholds and air-bone gap) were similar between the two groups.

Conclusions:

• The dual-station workflow for endoscopic tympanoplasty is feasible and safe.
• This workflow increases surgical capacity without compromising graft success, audiologic outcomes, or complication rates.
• The DS model provides a practical framework for outreach or ear-camp endoscopic ear surgery in resource-limited settings.